Provider Demographics
NPI:1336844141
Name:ANDERSON, BREANNA LEE (RDN)
Entity Type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FORDHAM BLVD APT 148
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-6033
Mailing Address - Country:US
Mailing Address - Phone:720-512-6552
Mailing Address - Fax:
Practice Address - Street 1:1300 FORDHAM BLVD APT 148
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6033
Practice Address - Country:US
Practice Address - Phone:720-512-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86116955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered